Monday, September 28, 2009

Rhode Island Medical Marijuana News

When Rhode Island opens its first medical marijuana dispensary, it will
join a select club.

Though 12 states have legalized marijuana for qualifying patients, only
California and New Mexico have authorized sale of the drug for medical
purposes –– a key difference for patients. That leaves Rhode Island
officials just two places to turn for guidance.

Since legalization there, California has emerged as something of a
troublesome stepchild of the movement. California's medical
marijuana centers are unregulated, which has led to safety problems and
prompted federal raids.

"It is entirely too messy a situation in my interpretation and I say
that as a Californian, " said Bruce Merkin, director of
communications for the Marijuana Policy Project, a group that advocates
for decriminalizing marijuana.

A 2006 law in New Mexico allowed the creation of dispensaries as part of
its "medical cannabis program." But the statute took time to
implement and the first of those centers did not open until late July,
having decided to use a delivery-only approach to serve the 600 patients
in the state's program.

"The only problem is that they ran out of their current supply,"
said Julie Roberts, acting director of Drug Policy Alliance New Mexico.
State regulations allow for the center to have a maximum of 95 plants,
which were quickly used up. The nonprofit group that runs the center is
now working to produce more and will begin deliveries again in October.

As Rhode Island moves toward the establishment of its first dispensary,
Stephen Hogan, executive director of the Rhode Island Patient Advocacy
Coalition, believes the operator selected to run it would be wise to
avoid a delivery service –– though Rhode Island law would allow it.

"When you have a delivery service there are a lot of issues that
come into play," he said, noting the frequent robberies of food
delivery people.

However Rhode Island's system evolves, other states interested in
establishing dispensaries will be watching to see what happens here, and
whether it works.

Efforts in several of those states to allow dispensaries have stalled in
recent years over concerns about the conflict between local statutes and
federal drug law, which bans the use of marijuana. But a promise by
Attorney General Eric Holder to stop the Bush-administration raids on
California clinics appears to have revived the issue in several states.

The late state Rep. Thomas Slater was a driving force behind legislative
efforts to create medical marijuana dispensaries.

The Providence Journal / Connie Grosch

Sometime next year, somewhere in Rhode Island, the state's first
marijuana dispensary will hold a deliberately quiet opening and patients
in the medical marijuana program will buy their first dose.

Depending on whom you ask, that dispensary can't come soon enough,
or it's a crisis waiting to happen.

For people who depend on marijuana to ease the pain of chronic or
debilitating illnesses, it will be a safe, reliable place to obtain the
drug.

But there's a long list of unanswered questions that have others,
particularly those in law enforcement, worried: Who's going to run
the center? Where will it be located? What security precautions will be
taken to make sure the center is not robbed?

Ellen and Stuart Smith say it's imperative that these issues are
resolved, to ensure a smooth opening of a clinic where Ellen can buy the
only drug that relieves her vice-like pain from Ehlers-Danlos syndrome,
a degenerative tissue disorder.

The crippling condition that displaces her joints is getting
progressively worse and now often requires her to use a wheelchair.
Allergies prevent her from taking almost all pain medications.

"Without this, she'd be dead," said Stuart Smith, her
husband of 36 years. "She's had 17 surgeries and this is all
that allows her to get out of bed in the morning."

The Smiths don't take kindly to marijuana jokes –– quips
suggesting that the law serves drug dealers and aging hippies. They are
neither. She is a 59-year-old retired schoolteacher and he, a
62-year-old former Department of Children, Youth & Families employee.
They are middle-class parents of four who came to marijuana as a last,
awkward resort when doctors had nothing else to offer.

But they are also fed up. They've struggled to grow the plant,
watched crops wilt and several times been victimized by thieves. Earlier
this month, local teenagers in the middle of the night sneaked onto
their wooded property in Scituate and snipped away two-thirds of their
lush plants.

A marijuana dispensary, they say, would relieve those headaches and give
Ellen Smith and the 953 other patients in the state's program a safe
place to purchase the drug.

"This is what's saving my life right now," Smith said, her
voice calm despite her obvious pain. "I don't know how long that
life is but right now this is getting me quality I wouldn't have. I
have four kids and grandchildren someday and I want to see them. This is
giving me that."

SIXTEEN MILES AWAY at Providence police headquarters, Lt. Michael E.
Correia, head of the narcotics bureau, awaits the arrival of Rhode
Island's first medical marijuana dispensary with growing unease.

Since the legislature legalized marijuana for medicinal purposes four
years ago, police departments around Rhode Island have seen firsthand
the problems that come with it.

In one instance, a patient authorized for medical marijuana use was
selling the drug out of his house, along with opiates and steroids. In
another, a cardholder was so inexperienced about how to grow marijuana
under intense indoor heat lamps, he started a fire in the basement of
his Olneyville home.

"There's already a tremendous potential for abuse with the
law," Correia said. Adding storefront dispensaries that grow and
sell the drug "is just doubling that potential for trouble" by
creating a new target for criminals interested in stealing marijuana.

The department's detective commander agrees. "Supporters of the
legislation are going to say that's not our problem. That's not
what the law is meant to do," said Maj. Thomas F. Oates III.
"But these centers are going to be someone's problem and,
really, it will fall to us."

The General Assembly gave final passage to the medical marijuana law in
2006 and made it permanent in 2007, both times over vetoes from Governor
Carcieri.

The law allows patients with debilitating medical conditions, such as
cancer, HIV and multiple sclerosis, to possess up to 12 marijuana plants
or the equivalent of 2.5 ounces of marijuana at any one time. They may
also select up to two "caregivers, " to provide it for them, so
long as those caregivers have no felony drug convictions.

What it didn't do was establish how patients and caregivers were
supposed to obtain the drug.

Almost immediately, the law's supporters, led by the Rhode Island
Patient Advocacy Coalition, began pushing for state-regulated marijuana
dispensaries, known as compassion centers, so patients wouldn't be
forced to grow it or buy it on the street.

While 12 other states allow marijuana use for medical reasons, only New
Mexico and California have legalized the sale of marijuana to qualifying
patients, though California's centers are not regulated by the
state.

Rhode Island lawmakers were initially wary of dispensaries, in part
because of the clash between state law and federal law, which still
makes marijuana use illegal. The Bush administration had raided several
such clinics in California, sending the message that state statutes
would be ignored.

But the Obama administration curtailed such raids, easing some of those
concerns.

On Smith Hill, the quickly fading opposition had more to do with the
efforts of Providence Rep. Thomas C. Slater, the state legislator behind
the original medical marijuana bill. Slater was losing a long battle
with breast cancer, a condition which made him eligible for the medical
marijuana program. (He enrolled, but he said he never used the drug.)

His impassioned speech on the House floor in May about the ravages of
pain prompted a standing ovation and left several representatives near
tears.

Both the House and Senate overwhelmingly passed compassion center bills
that just a year earlier had died in committee. Then they quickly
overrode Carcieri's veto, and the bills became law in a session when
nearly every other major social initiative sputtered to a stop.

The law requires the Health Department to prepare for the first of up to
three dispensaries; in August, it released a 22-page draft of
regulations that outline what potential candidates need to know to apply
to run the first center.

Once department officials select an operator sometime early next year,
they will assume an oversight role, regulating the facility much as they
do pharmacies and nursing homes.

Health Department Director Dr. David Gifford acknowledges the state is
in unfamiliar territory.

"We're going to do the best we can with our staff, but there
isn't much to go on," he said, noting the lack of forerunners in
other states. Even New Mexico's experience offers little guidance
because its one medical marijuana center is a delivery service, not a
storefront clinic.

The police and patients say part of the problem is that the Assembly
passed a law that was in some ways vague. It doesn't specify how the
police are to be involved, or require any professional expertise of
those selected to run the center, although they can't have felony
records. It also doesn't address how much they can possess, and what
is an appropriate dose for a drug whose strength can vary widely.

And it didn't provide any funding for the Health Department to get
the program up and running.

At an information session in August for those interested in opening a
center, Charles Alexandre, the Health Department official tasked to
oversee the clinics, in addition to his other responsibilities, could
not answer many of the questions he was asked.

"I don't think the Health Department really understands what
it's getting into," said Dr. Todd E. Handel, a Pawtucket
physician who specializes in pain management and has recommended
marijuana usage to several of his patients. "This is something
that's really been forced down their throats by the legislature and
I don't think the department really wants to be involved, or has the
funding to do this."

Gifford admits there are challenges, but says the department oversees a
range of businesses, from nail salons to x-ray clinics. Once an operator
is selected, health officials will work with them to make sure proper
security and management procedures are established. "There's no
facility, even ones that are much more high risk to people's health
where we have people monitoring every day, not even brain surgery,"
Gifford said.

But police departments are deeply worried by that paucity of details.
They question how an operator can be trusted to sell marijuana only to
those authorized to buy it and how they will keep their supplies of
marijuana safe from theft. They're already frustrated by their
inability to obtain the names of patients and caregivers, which has led
to investigations of people they later learned were legally growing or
using the drug. When the centers open, it's unclear whether police
will have jurisdiction over them. "In a perfect society, we have
this place where marijuana is going to be grown and provided to patients
and caregivers," said State Police Capt. David Neill. "But
unfortunately you always have a criminal element to think about. People
are going to look at this center — where there will be a lot of
money involved — and ask `How can I get in?' "

Rep. Joseph Almeida, D-Providence, who voted in favor of compassion
centers this spring, now agrees that the law needs work. He is
considering drafting legislation that would give the police a strong
role in the monitoring of compassion centers.

For Handel, the Pawtucket pain doctor, the bigger risk may be the
potential lack of medical oversight. The statute does not require the
centers to have any affiliation with medical professionals. By contrast,
New Mexico requires marijuana dispensaries to have a health-care
professional on their boards. "If someone is going to supply
medication to a patient, they need to be able to monitor what the
benefits are as well as the adverse effects," Handel said.

At a pharmacy, he notes, professionals track how much medicine a patient
is given, and are available to warn about possible side effects.
"The way this is set up there is no physician and no pharmacist
monitoring intake," Handel said. "There is no one keeping an eye
out for abuse."

ELLEN SMITH, the Scituate marijuana patient, agrees there is the
potential for problems.

"We need to get this right," she said. "We are being watched
by all the other states that might be considering this. If we don't
set a good example with the first center, we could be blowing it, not
just for ourselves but for the entire country."

Smith gets visibly angry when she talks about those looking to abuse the
marijuana statute. "We need to find a way to get rid of these people
because there's a whole bunch of us who are not well and desperately
need this law," she says.

Two days after the Smiths sat down to discuss the importance of the
dispensaries, they say they got another reminder of why they're
needed. They were robbed. Again.

Teenagers cut away four plants that were lush and close to harvest,
despite the Smiths' elaborate laser alarm system and the fact that
Stuart Smith had been sleeping on the porch to ward off intruders.

The Smiths got lucky. They were able to identify the thieves and got
pieces of the plants back for Ellen to process into oil that she takes
once a day.

But when you're 59 and you've lost much of the life you knew and
the teaching job you loved to illness, there's only so much you can
take.

"This is just one more example of why we need these centers,"
Smith said. "We feel terrorized, we feel frightened and we don't
deserve to live like this."

With reports from W. Zachary Malinowski

Medical marijuana by the numbers

954.

Patients in Rhode Island's medical marijuana program 764.

Caregivers authorized to grow or procure marijuana for patients

1. Patient registration cards revoked because of a marijuana-related
arrest